There have now been two Acts of Parliament in the United Kingdom, the first act in 1995 (the Prohibition of Female Circumcision Act) and the latest being the Female Genital Mutilation Act of 2003. However we believe that women in this ethnic group, some as young as 4 years old, remain at risk.

It is also difficult to find out if these procedures still take place in the UK. Most young girls are taken out of the country to have the ritual carried out. The new Act of 2003 was set up to protect them from leaving the country.

The medical profession, social services, teachers and the child protection agencies need to work more closely to protect these individuals.

Worldwide 2 million young women remain at risk of being subjected to this ritual every year.

The article describes how statistical data is available, particulary from America, to guide the clinician and the Court. This data acts as the starting point. The two factors that affect life expectancy most of all in the data are mobility and feeding ability, hence tables and survival curves are provided within the publications cited so that additional years of survival can be assessed for individuals in the different functional groups. The article describes how it is the clinicians' role to assess the individual's functional capabilities and any relevant clinical issues and ‘interpret’ the data accordingly.

This paper reviews the medical literature and legal case law surrounding OBPI and presents a template for reviewing the strength of evidence for OBPI in clinical negligence claims. The template contains factors more likely to be present if the OBPI was caused by the maternal forces of labour ‘propulsion injury’ (injury to the posterior arm, no documented evidence of shoulder dystocia, up-to-date training, appropriate shoulder dystocia management, no evidence of excessive traction, correct number of birth attendants, precipitous second stage, temporary injury) and factors more likely if the injury is iatrogenic (injury to the anterior arm, shoulder dystocia, no recent training, incorrect shoulder dystocia resolution manoeuvres used, evidence of excessive traction, insufficient birth attendants, fundal pressure, permanent injury). Each factor does not, in itself, establish causation, but the template may provide a useful aid to legal teams reviewing medical notes.

Focusing on death and severe harm through unambiguous human error (a good place to start), the most obvious way to reduce such events is to educate frontline clinical staff about the science of safety – how this has been developed in other fields of human endeavour and how it translates to healthcare. This will take time – a professional generation, probably, as the young are more amenable to new practices than the old. There are other obstacles, including disincentives to report mishaps and a present lack of professional ownership of the safety initiative. But as awareness grows the pace of change will accelerate and better data will give a clearer picture of what is going on.

The press is littered with heartbreaking stories of superbugs: 33 die and 334 are infected due to an outbreak of Clostridium difficile at Stoke Mandeville Hospital; 90 die following a similar outbreak at Maidstone Hospital; a two-day old baby dies from MRSA at Ipswich Hospital; a mother dies of MRSA shortly after giving birth at Stoke-on-Trent Hospital; a young nurse dies, a male patient nearly dies and 17 others are infected after a pseudomonas outbreak at Guy's Hospital. There are many others. It is a major national problem. Despite this, we are told only of the tip of the iceberg. In addition, one would hope that the law provided appropriate redress to superbug victims, but this is often not the case.